🦴

Cervical Spine Pathologies (Lecture Video)

Apr 23, 2025

Orthopedic Assessment of the Cervical Spine

Importance of the Cervical Spine

  • Critical segment in the spinal column.
  • Understanding patient history is vital for diagnosing pathologies.

Key Points in Patient History

  • Activities Affecting Symptoms: Identify activities or prolonged postures that increase symptoms.
  • Pain Location: C1-C4 vertebrae related pain wouldn't impact extremities.
  • Sensory Symptoms: Paresthesia, tingling, anesthesia - assess if unilateral (nerve root) or bilateral (spinal cord/meninges).
  • Sleep Disturbances: Grade 2 and 3 tissue damage might cause sleep issues.
  • Age Considerations: Degeneration common after age 45, nearly universal after 65.
  • Mechanism of Injury: Distinguish between chronic and acute injuries.

Pain and Pathology

  • Pain with Movement: Indicates mechanical pathology; repetitive movement points to specific flexion/extension issues.
  • Chemical Pain: Persistent across movements, indicating different pathology.
  • Previous Injuries: Strong predictor of future issues.
  • Pain Source: Localized pain suggests muscle/ligament/facet joint involvement, whereas radiating pain suggests nerve root/spinal cord issues.

Ergonomics and Posture

  • Importance of assessing ergonomic posture, particularly for sedentary individuals.
  • Common issues such as cervical tension headaches linked to sustained neck posture.

Differential Diagnosis

  • Unyielding Pain: Possible disc rupture or serious conditions like tumors.
  • Symptoms Beyond Cervical Spine: Persistent dizziness or tinnitus suggests non-orthopedic issues.
  • Ligament Trauma Indicators: Fearful movement, muscle spasms, focal pain.

Radiculopathy vs. Myelopathy

  • Radiculopathy: Unilateral symptoms from nerve root compression.
  • Myelopathy: Bilateral symptoms indicating spinal cord involvement.

Common Cervical Spine Disorders

  • Spondylosis: Degenerative changes in zygapophysial/facet joints, common in aged individuals.
  • Herniated Discs: Common in C4-5 and C6-7, often due to repetitive flexion.
  • Stenosis: Narrowing of spinal canal, often age-related, leading to bilateral symptoms.
  • Whiplash: Results from sudden extension/flexion, potentially injuring muscles, ligaments, or causing herniation.

Acute Cervical Spine Injuries

  • Axial Load Injuries: Most catastrophic; importance of ruling out fracture/dislocation before special tests.
  • Mechanism of Injury: Axial load with flexion/rotation most likely to cause severe injury.
  • Signs of Serious Injury: Bilateral deficits, odd postural responses indicate possible spinal cord damage.

Special Considerations

  • Transient Quadriplegia: Temporary loss of function post-impact; needs spine boarding and imaging.
  • Spear Tackler's Spine: Result of improper tackling techniques causing axial loading.
  • Muscle Strains and Whiplash: Common from acute impacts, involve muscle, joint capsule, or ligaments.

Bracho Plexus Neuropraxia (Stingers)

  • Causes: Stretching, compression, or direct trauma to brachial plexus.
  • Common in Sports: Especially football; transient symptoms with a high recurrence rate.

Assessment and Management

  • Assessment Tools: Includes bracho plexus stretch test, Spurling’s test, imaging if fracture suspected.
  • Management Strategies: Vary from rest and supportive gear to potential surgical interventions in severe cases.
  • Return to Play Criteria: Full strength, no symptoms, full ROM required.

Clinical Prediction Rules for X-Ray

  • Guidelines for when to pursue imaging based on age, mechanism of injury, symptoms, and neck mobility.

These notes cover important aspects of cervical spine assessment and management, focusing on anatomy, potential injuries, and clinical evaluation strategies.

Full transcript